To be honest, I’m a little intimidated. McManamy is the author of McMan’s Depression and Bipolar Web, an encyclopedic site of the sort that makes me wonder what aspects of this disease haven’t already been hashed over on the internet in some detail. I highly recommend both the book and the site; I’ll discuss the former today, and the latter tomorrow — or when I get to it, whichever comes last.

The book is divided into four parts: “Diagnosis,” “Brain Science 101,” “Roads to Recovery,” and “Special Populations.” We’ll travel through the book by sections.

It is, perhaps, unfortunate that McManamy begins the book with such a lengthy and, well, depressing discussion of the two diseases. Unlike so many books and sites, he doesn’t pull any punches. He makes it clear that mood disorders are brutal, and that it will take plenty of hard work and all of your ingenuity to avoid suicide and live a decent life. While most books candy-coat the diagnosis, merely saying that you have a “broken brain” that can be made right with meds, McManamy argues that existing meds are at best crude tools, and that for most people, a diagnosis is the beginning of a long — perhaps lifelong — carousel of medications and side effects both trivial and crippling. The first section, then, on diagnosis, is a downer, and it’s a bit of a struggle to get from there to more hopeful sections on recovery.

I don’t blame McManamy for his approach, however. Too often, as David Karp points out in The Burden of Sympathy, health care providers both oversimplify the impact of the disease, and, at the same time, tend to give up on patients, essentially telling them that they will never live a normal life. While the latter may be true, the first two are inexcusable, and though McManamy’s approach may sadden you, it is realistic. After all, either disease can prove fatal, either through suicide or comorbidities, and existing medical therapies are partial at best.

In this first section, McManamy gives an excellent phenomenological sense of mood disorders — that is, he describes the feeling of having them from the inside. He also presents an argument that he will stick to though the next 300 pages: he considers depression and manic depression to be two faces of the same illness, bipolar spectrum disorder. In essence, he believes that many depressed people are just one bad antidepressant trip away from a diagnosis of bipolar disorder, and, as he points out, bipolar people spend most of their time depressed, and with a diagnosis of major depression. In his opinion, then, a firm distinction between the two is a false one. Though both diseases take many, many forms, and we can draw some distinctions between bipolar and unipolar depression, the two are intertwined, both in the experience of sufferers and in treatment.

In this first section, McManamy describes and analyzes the most terrifying and discouraging aspects of both diseases, and lays out clearly their ability to destroy the lives of patients and the people around them. He provides an unflinching picture of the isolating effect of depression, and lays out how common co-occurring conditions such as substance abuse and anxiety are. Neither disease is to be taken lightly, he writes; both require tremendous determination and resources if sufferers hope to live with dignity and some enjoyment.

The second section, “Brain Science 101,” should probably be titled, “Brain Science 401” — rather than the same old outdated and oversimplified description of how neurotransmitters work, McManamy explores cutting-edge research that suggests that therapies directed at boosting neurotransmitter availability may be crude at best compared to the subtle processes of the brain.

McManamy also provides a nuanced account of the current confused state of genetic research into bipolar spectrum disorders. Again, he moves beyond even the more subtle discussions one typically finds — the ones that talk about a combination of genetic vulnerability combined with triggering events — to explore the complexities of how genes turn on and off production of various proteins, and how these proteins appear to work in the brain and elsewhere. I learned more from this section than even the most sophisticated extant textbook, Goodwin and Jamison’s tome Manic Depressive Illness, which does, after all, date back to 1990. His discussion of depression, in particular, goes well beyond what is available elsewhere.

Once the reader has negotiated these two formidable sections, she finally gets some useful, if limited, good news. It is possible, of course, to combat the diseases on several fronts, from nutrition to exercise to mindfulness meditation and yoga, and that’s what McManamy recommends. He states unequivocally that it is never enough simply to pop a pill, or even a half-dozen pills, and to expect to recover. His refreshing decision to deal with complimentary treatments before turning to meds places the emphasis on what you can do — must do — to combat either malady with some success. Only then does he move on to a thoughtful and detailed dissection of available medical treatments and talk therapy.

Though there is, in his words, “No Magic Bullet,” it is, he argues, our right to expect remission and normal functioning. This is a remarkably optimistic stance given the litany of horrors that take up the first two sections. Even so, I find myself totally agreeing with him. If your doctor writes you off and suggests that you’re incapable of working or sustaining a relationship, in my opinion, you need to find doctor who will work tirelessly with you to find a combination of medical and alternative treatments that will help you to achieve the highest level of functioning of which you are capable — which is probably higher than either you or your doctor may expect upon initial diagnosis.

From here, McManamy moves on to discuss “Special Populations” — children and the elderly — and to consider the special challenges facing each of the sexes, from postpartum psychosis to “Why Psychiatry Fails Men.” He even weighs the question of whether we should have children, given the severity of the two diseases, concluding that the chances of raising a normal child outweigh the odds of passing on either disease.

Each part of the book contains many more intriguing details than I can possibly convey here. A few tidbits that caught my attention:

His assertion that “We may hate our illness, but we can hardly hate what our illness has made of us,” which goes hand-in-hand with his claim — true, I believe — that our courage is incredible even when our outcomes and behavior are less than stellar;

A large study that indicates that “symptomatic individuals [are] only half as likely to marry and twice as likely to separate or divorce,” a finding that has been borne out in my own life and the lives of many of my bipolar friends;

A spirited debate on whether we are special and sensitive, or simply cursed

The excellent suggestion that “[t]hose who are unable to work … do a day or two a week of volunteer work” to lend structure to their lives and gain the feeling that they contribute to society;

Advice that you enjoy “the serotonin benefits of a pet”;

And the recommendation, when it comes to reaching goals, you “start anywhere” rather than getting bogged down in calculating the perfect place to begin;

Finally, he concludes with a truly compelling statement:

Writing is what helped to bring me back from the dead. For me, it is a healing activity. If I were a basketball player, I would be shooting hoops; if I were a gardener, I would be out with the petunias. Healing is about finding something that makes you feel alive and doing it.

So true. I keep telling you that here because I believe it. As with anyone, the more you pursue your passions, the more likely you are to succeed in all areas of life, and to become a person you’d like to meet. He ends, then, on a surprisingly upbeat note: It’s a bloody struggle, but it is possible to survive and thrive. I couldn’t agree more.

It should be clear by now that I give this book the highest possible recommendation. Combined with more specific works that will help you to implement his suggestions for wellness, it may bring you a good deal of relief. Certainly it will reward you with a tremendous store of knowledge with which to make informed decisions about your treatment.

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[…] to be realistic and honest without giving up hope. John McManamy’s book, which I’ve reviewed in this space, manages to walk this line. He’s realistic about how tough and wily the disease actually is. […]

Many many thanks for your thoughtful review of my book, which is by far the best I have read. The effort you put into this would have made even a negative review useful to me, but I am extremely happy you gave me a thumbs up. I especially appreciate how you came to grips with my seemingly contradictory message of despair and hope.

Thank you for having written such an informative book — I learned a good deal from it, and I’m betting that my readers will, too. It’s great to read s book that goes beyond the usual oversimplified explanations of the genetic and chemical components of bipolar disorder and depression.

Just reading your review, I make my mind that I am going to purchase this book. This is really nice review. Bipolar disorder is a mental illness that affects many children and adults today. It was known in the past as manic-depression and is still called that by a lot of lay people. This disease is well known for the change in moods. People with this illness cycle from one extreme type of mood to the other.

Revolt and Resignation

In his collection of essays On Aging, Holocaust survivor Jean Amery said that one must meet the phenomenon of aging -- inevitable yet terrifying -- with both revolt and resignation. So it is with mental illness. To deny that I will always be manic-depressive would be true madness; at the same time, I must revolt against my condition, rejecting the idea that it defines and limits me.